Huge rise in coronavirus cases casts doubt over scale of epidemic

Sarah Boseley and Lily Kuo

The true scale of the epidemic caused by the new coronavirus in Hubei province has been thrown into doubt after the Chinese authorities reported more than 13,300 extra cases going back over an unknown number of days or weeks.

The World Health Organization (WHO) said the huge jump in cases in Hubei, bringing the total to more than 60,000 worldwide, was due to a change in the way Chinese authorities was counting them.

Cases where doctors have seen chest infection on a CT scan are now being classed as coronavirus rather than just those confirmed by a lab test result, leading to a 254 rise in deaths to a total of 1,370 since the outbreak began. All but two of the deaths have been in China.

In addition to the 13,332 extra cases, Chinese authorities on Thursday reported a further 1,820 laboratory-confirmed cases.

The WHO is now working hard to try to get further details of when the extra cases of what is now being called Covid-19 occurred, to have a true picture of how the epidemic has been developing in Wuhan and other cities in Hubei.

“Most of these [additional] cases relate to a period going back days or weeks,” said Dr Michael Ryan, the WHO’s head of emergencies. “It is retrospective reporting. It is largely due to how cases are being diagnosed and reported.”

Graph of cases

On the positive side, it meant Hubei’s doctors would be able to report cases more quickly because they no longer have to wait for lab confirmation, said Ryan.

The political fallout from the outbreak also escalated on Thursday with the firing of Hubei’s party chief, the party chief of Wuhan and the head of China’s Hong Kong and Macau affairs office. Ying Yong, the new party chief of Hubei, came up through the ranks in Zhejiang – where President Xi Jinping, previously served as party secretary – and was also part of anti-corruption campaigns, the president’s signature initiative.

“This is clearly Xi’s move,” said Dali Yang, a professor of political science focusing on China at the University of Chicago. “The stakes are high and he needed time to find the right people for the positions to salvage the Hubei, Wuhan situation.”

A man measures people’s body temperature at a roadblock in Guangzhou, China. Photograph: Alex Plavevski/EPA

On Wednesday, the state-run China Daily reported that a powerful Beijing official parachuted into Wuhan to supervise the fight against the virus had reprimanded local officials for failing to organise treatment quickly enough for people reporting to hospitals with symptoms.

Thursday’s jump in infections may have been another impetus for the purges. “I suspect Xi would have wanted the personnel change to project a sense that he is in control of the situation. The bad numbers undermine that message,” said Sam Crane, who teaches Chinese politics and ancient philosophy at Williams College in the US.

Prof Paul Hunter, a coronavirus expert from the University of East Anglia, said cases that in the past would only have been considered suspect would now fell into the confirmed bracket. Many would-be Covid-19 cases that would have been confirmed if lab tests had been done, but the figures would also include some people who had pneumonia not caused by the coronavirus.

What is the virus causing illness in Wuhan?

It is a member of the coronavirus family that has never been encountered before. Like other coronaviruses, it has come from animals. Many of those initially infected either worked or frequently shopped in the Huanan seafood wholesale market in the centre of the Chinese city.

What other coronaviruses have there been?

New and troubling viruses usually originate in animal hosts. Ebola and flu are other examples – severe acute respiratory syndrome (Sars) and Middle Eastern respiratory syndrome (Mers) are both caused by coronaviruses that came from animals. 

What are the symptoms of the Wuhan coronavirus?

The virus causes pneumonia. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties. In severe cases there can be organ failure. As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against flu will not work. If people are admitted to hospital, they may get support for their lungs and other organs as well as fluids. Recovery will depend on the strength of their immune system. Many of those who have died were already in poor health.

Is the virus being transmitted from one person to another?

China’s national health commission has confirmed human-to-human transmission, and there have been such transmissions elsewhere. As of 12 February there are now 45,182 confirmed cases and 1,115 deaths. There are cases in 28 other countries outside China, with deaths recorded in one case in Hong Kong, and one case in the Philippines. The number of people to have contracted the virus overall could be far higher, as people with mild symptoms may not have been detected.

The number of confirmed cases of coronavirus in the UK has doubled from four to eight after four more people in Brighton were diagnosed with the infection over the weekend.

One of the other four confirmed cases is being treated at the HCID unit at the Royal Free hospital in north London, and the two Chinese nationals who tested positive for Coronavirus in York are being treated at the HCID centre in Newcastle.

Why is this worse than normal influenza, and how worried are the experts?

We don’t yet know how dangerous the new coronavirus is, and we won’t know until more data comes in. The mortality rate is around 2%. However, this is likely to be an overestimate since many more people are likely to have been infected by the virus but not suffered severe enough symptoms to attend hospital, and so have not been counted. For comparison, seasonal flu typically has a mortality rate below 1% and is thought to cause about 400,000 deaths each year globally. Sars had a death rate of more than 10%.

Should I go to the doctor if I have a cough?

Unless you have recently travelled to China or been in contact with someone infected with the virus, then you should treat any cough or cold symptoms as normal. The NHS advises that people should call 111 instead of visiting the GP’s surgery as there is a risk they may infect others.

Is this a pandemic and should we panic?

Health experts are starting to say it could become a pandemic, but right now it falls short of what the WHO would consider to be one. A pandemic, in WHO terms, is “the worldwide spread of a disease”. Coronavirus cases have been confirmed in about 25 countries outside China, but by no means in all 195 on the WHO’s list.

There is no need to panic. The spread of the virus outside China is worrying but not an unexpected development. The WHO has declared the outbreak to be a public health emergency of international concern, and says there is a “window of opportunity” to halt the spread of the disease. The key issues are how transmissible this new coronavirus is between people and what proportion become severely ill and end up in hospital. Often viruses that spread easily tend to have a milder impact.

Sarah Boseley Health editor and Hannah Devlin 

“The issue remains how are we going to be able to say what is happening with the trajectory of the outbreak when the cases definitions change midway through the epidemic?” Hunter said. “Will the figures be backdated? Also, what about cases that have a clinical diagnosis but negative lab tests, are they included in the confirmed cases or not?

“I have no problem with people using different case definitions but please be consistent or if you do change, run both in parallel for a few days so that no one believes the epidemic has suddenly got a lot worse. I suspect but can’t be certain that the underlying trend is still downwards.”

Vietnamese olice wearing masks guard a road checkpoint outside Son Loi near Hanoi which is on lockdown due to coronavirus. Photograph: Yves Dam Van/AP

The rest of China is only reporting confirmed cases of Covid-19 infection. So are the 24 countries that have declared cases, which so far number 447 outside of China with two deaths – in the Philippines and Japan. “We are not seeing a dramatic increase outside of China,” said Ryan. The largest cluster was the 218 confirmed cases on the Japanese cruise ship Diamond Princess.

Nor, he said, are they seeing any significant shift in the pattern of mortality or severe illness. Those who were severely ill tended to be male and over 40 – and the more severe, the older they are, with the most dangerous cases in the 60s, 70s and 80s, Ryan said.

He suggested the best hope in the near future lay in the trials of existing antiviral drugs, which include some that are in use against Aids and HIV. Trials have started in China and it is hoped they will be extended to countries such as Singapore and Japan, both of which have significant numbers of cases. “You can imagine being a frontline clinician at the moment. Knowing which drug works would be a magical gift,” said Ryan.

The change in China to include what are known as “probable cases” appeared aimed at heading off complaints about the availability of tests and treatment for residents, as well as questions about whether officials have been underreporting cases.

The shortage of the testing kits has meant many sick residents have been unable to seek treatment, with hospital admission contingent on the test result. Health workers have been calling for authorities to broaden the parameters for diagnosing in order to treat more patients. Some have also questioned the reliability of the tests.

The crisis has also deepened in Hong Kong, where the education minister announced that schools would remain closed until at least the middle of March. They have been closed since the start of the lunar new year at the end of January.

In Vietnam, the authorities announced the lockdown of the commune of Son Loi, a farming region about 25 miles from Hanoi, for 20 days. Checkpoints were set up around the commune and health officials wearing protective suits sprayed disinfectant on vehicles.